BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 595|
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THIRD READING
Bill No: SB 595
Author: Speier (D)
Amended: 4/28/99
Vote: 21
SENATE BUSINESS AND PROFESSIONS COMMITTEE : 5-0, 4/19/99
AYES: Figueroa, Kelley, Murray, O'Connell, Speier
NOT VOTING: Johannessen, Polanco
SENATE APPROPRIATIONS COMMITTEE : 7-5, 5/17/99
AYES: Johnston, Alpert, Bowen, Burton, Escutia, Karnette,
Perata
NOES: Johnson, Kelley, Leslie, McPherson, Mountjoy
NOT VOTING: Vasconcellos
SUBJECT : Outpatient settings: health facilities
SOURCE : Author
DIGEST : This bill expands the definition of outpatient
settings that are subject to accreditation, and to
regulation by the Medical Board of California, and adds
several requirements for outpatient setting accreditation.
ANALYSIS : Existing law:
1.Provides for the licensure and regulation of
clinics, as defined, and health facilities, as
defined, by the State Department of Health Services
(DHS).
CONTINUED
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2.Provides for the licensure and regulation of
physicians by the Medical Board of California in the
State Department of Consumer Affairs (DCA).
3.Provides for the regulation of outpatient settings
by the Division of Licensing of the Medical Board;
and
A. Defines an "outpatient setting" as: any
facility, clinic, unlicensed clinic, center,
office, or other setting that is not part of a
licensed general acute care facility, where
specified anesthesia is used in compliance with
community standards, in doses that when
administered have the probability of placing a
patient at risk for loss of his or her
life-preserving reflexes.
B. Excludes from the definition of outpatient
settings: local anesthesia, peripheral nerve
blocks, and anxiolytics and analgesics
administered in compliance with the community
standard of practice in doses that do not meet
the level specified in (A).
4.Prohibits any physician from performing surgery in
an outpatient setting using the level of anesthesia
specified in 3) (A) above, unless the setting is one
of enumerated health care settings, including a
setting that is accredited by an accreditation
agency approved by the Medical Board's Division of
Licensing.
This bill:
1.Expands the definition of an "outpatient setting"
that is subject to regulation by the Medical Board
by deleting the current meaning based on a specified
level of anesthesia and, instead, applying it to
facilities where any anesthesia, including
intravenous, intramuscular, or rectal sedation or
analgesia, is administered but excluding local
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anesthesia, minor blocks, or minimal oral
tranquilization.
2.Prohibits, on or after July 1, 2000, physicians from
performing procedures in unaccredited outpatient
setting using any anesthesia other than local
anesthesia, minor blocks, or minimal oral
tranquilization.
3.Requires outpatient settings to post, in a readily
visible place, its accreditation certificate, the
name and telephone number of the accreditation
agency, and instructions on the submission of
complaints.
4.Requires accredited outpatient settings, as well as
settings that are excluded from accreditation
requirements, to have a minimum of two staff
persons, including one licensed health care
professional present whenever there is a patient on
the premises who has not been discharged from
supervised care. Also, requires both types of
settings to have written discharge criteria and
makes it unprofessional conduct to transfer a
patient who does not meet the discharge criteria.
5.Requires the Division to notify the public, upon
inquiry, whether an outpatient setting's
accreditation has been denied.
6.Requires an accreditation agency to notify the
Division of the reasons for denial of an outpatient
setting's accreditation, and requires an outpatient
setting that has been denied accreditation to wait
at least one year after notification of
accreditation denial before reapplying for
accreditation.
According to the Senate Business and Professions
Committee analysis:
1.Purpose. According to the author, SB 595 is
intended to clear up the ambiguity regarding the
anesthesia threshold for triggering accreditation of
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an outpatient setting. Concerns have been raised
since the enactment of the outpatient setting law in
1994 by the author's AB 595. According to the
author, this has led to misinterpretation of the law
and circumvention of the accreditation requirement
by those it was intended to regulate. The author
states the bill provides a clear "bright-line"
definition for determining which facilities must be
accredited.
2.Background. According to the author, the Federal
Office of the Inspector General reports that more
than 51 percent of all surgery which traditionally
has been performed in regulated hospitals is now
performed in ambulatory centers, clinics, physician
offices and other outpatient settings. By the year
2000, it is estimated that 87 percent of all
surgeries will be performed in non-hospital
settings. AB 595 (Speier, Chapter 1276, Statutes of
1994) was enacted to regulate unlicensed outpatient
settings where specified levels of anesthesia are
used. The purpose of that legislation was to
provide some additional protection to patients
undergoing surgery in those environments. Since
enactment, approximately 400 office-based surgery
facilities have become accredited outpatient
settings.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 1999-2000
2000-01 2001-02 Fund
Medical Board potential increase in regulated
settingsCFMB*
*Contingent fund of the Medical Board
SUPPORT : (Verified 5/19/99)
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Medical Board of California
California Society of Anesthesiologists
California Society of Plastic Surgeons
OPPOSITION : (Verified 5/19/99)
California Medical Association
California Dermatology Society
ARGUMENTS IN SUPPORT : According to the author,
there has been ongoing disagreement as to the precise
meaning of the anesthesia standard in current law that
triggers accreditation requirements and related
patient safety measures. The author believes that the
subjectivity and ambiguity of the current anesthesia
standard has made it difficult to properly enforce the
law, thereby allowing some outpatient centers to avoid
the accreditation requirements and placing their
patients in jeopardy. The author believes that the
bill will provide a more definite and enforceable
anesthesia standard that provides a reasonable basis
for determining when specified safety requirements
should be required.
ARGUMENTS IN OPPOSITION : The California Medical
Association (CMA) opposes the change in the anesthesia
standard that triggers accreditation because of the
change in focus from the effect on a patient to one
that specifies particular modalities of anesthesia
administration. The CMA wants more information from
the Medical Board regarding patient harm cases and
issues directly related to the use of the current
definition. Additionally, CMA believes that the new
standard will subject physician offices that do not
engage in procedures of significant risk to patients
to unnecessary accreditation regulation.
In addition, CMA opposes the bill's requirement that
there be two staff, one of whom is a licensed health
professional, present whenever a patient is on the
premises. CMA believes this staffing level may be
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unnecessary in certain settings, should not be applied
equally to accredited and unaccredited settings, and
that any staffing standards should be included in a
setting's discharge criteria rather than as an
independent requirement.
Lastly, CMA opposes the requirement that the Medical Board
report accreditation denials to the public upon inquiry
because it believes that an outpatient setting could
potentially be harmed by such a disclosure which may have
resulted from a defect that was easily correctable and
corrected by the setting. Further, the CMA opposes making
an outpatient setting wait 12 months after a denial of
accreditation before it may reapply because the denial may
have resulted from a defect or defects that are easily
correctable in a much shorter period of time.
CP:kb 5/19/99 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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